Pain And Physical Therapy: 9 Things You Should Know


Pain can interfere with everyday activities and affect quality of life. Most pain can be treated without prescribed opioids with the help of a physical therapist. Physical therapists are movement experts who treat pain through hands-on care, patient education, and prescribed movement.

Here are nine things physical therapists want you to know about pain.

1. Pain is output from the brain.

We used to believe that pain originated within the tissues of our body. We now understand that pain does not exist until the brain determines it does. The brain uses a virtual "road map" to direct an output of pain to tissues that it suspects may be in danger. This process is a means of communication between the brain and the tissues of the body, and serves as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain.

Research has demonstrated that we all experience pain in individual ways. While some of us can experience a major injury with little pain, others have a minor injury with a lot of pain (think of a paper cut). Nerves adapt by increasing their resting level of excitement. A nerve can become more, or less, sensitive. A host of different things can cause that change, and many of them are driven by things that happen in our brain, in the local tissue, in neighboring areas of the body, or outside of our bodies.

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding(s) may not be the cause of your pain.

A study on people 60 years or older who had no symptoms of low back pain found that:

  • 36% had a herniated disc.

  • 21% had spinal stenosis.

  • More than 90% had a degenerated or bulging disk, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse.

Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed before a total knee replacement were linked to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain.

The context in which you are injured plays a very profound role in how we experience danger and threat, which is what determines our pain. Circumstances that we welcomed, that brought injury, are often not perceived as threats, or at least not as threatening. Circumstances that we did not welcome, that brings the same injury, can often be perceived as much more of a threat.

A good illustration of this is the difference between participating in a demolition derby and being in a car accident. The damage that happens in both instances is similar, but the pain suffered by the drivers in each one greatly differs. The demolition derby driver welcomes the sudden impact of the collision of cars and thus the pain and injury they suffer at such an event is greatly reduced when compared to someone who is blind sided by car accident.

6. Understanding pain through education may reduce your need for care.

A large study looked at people in the military and found that those who were given a 45-minute educational session about pain sought care for low back pain less than their peers. The more we educate ourselves, the more ability we will have to manage the experience of chronic pain.

7. Our brains can be tricked into developing pain in prosthetic limbs.

Studies have shown that our brains can be tricked. They can develop a "referred" feeling in a limb that has been amputated, and cause "pain" that seems to come from a prosthetic limb – or the "phantom" limb. The feeling is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (after amputation).

8. The ability to determine left from right may be altered when you experience pain.

Networks within the brain that help you determine left from right can be affected when you have severe pain. If you have pain, and have noticed your sense of direction is a bit off, it may be because the "roadmap" in the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto paper roadmap and then trying to use that map to get to your destination.)

9. There is no way to know whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way.

While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among people. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."

If you have pain that limits your movement or keeps you from taking part in work, daily living, and other activities, a physical therapist can help. Physical therapy is a safe treatment for people with acute or chronic pain.

Freudenthal employs physical therapists specifically trained in dealing with pain. Dr. Read Wall is one of our certified therapeutic pain specialists (TPS). With this certification, Dr. Wall brings a new level of treatment to our physical therapy team. Therapeutic pain specialists strive to look at pain in a new way by classifying it in 3 different categories: nociceptive pain, neuropathic pain, and nociplastic pain. Each category has its own criteria and physical symptoms that Dr. Wall uses when generating his plan of care.

If you are dealing with pain, you can request a physical therapy evaluation either through our team at Freudenthal or through your primary care physician. You never know how much a little PT can help change your whole outlook on life.

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